Review by Heather Stewart
Genderqueer and Non-Binary Genders (Palgrave MacMillan 2016) offers the first sustained, comprehensive academic and clinical resource specifically focused on non-binary gender. As such, the book is a massive undertaking. It aims to explore non-binary gender experience in a variety of realms: social life and activism, mental health and related institutions, and clinical medicine. The editors of the collection themselves span an impressive array of backgrounds: Christina Richards is a psychology associate and clinical researcher at the National Health Service (NHS), as well as an activist and educator around trans and non-binary issues; Walter Pierre Bouman is a medical doctor, psychiatrist, and psychotherapist specializing in gender and sexuality; and finally, Meg-John Barker is a writer, therapist, and activist-academic, specializing in gender and sexuality. Their diverse educational and professional backgrounds have contributed to the creation of a text that is equally diverse and expansive, and which is strengthened by the incorporation of voices from various specialists and experts on non-binary gender (each chapter is authored by different people who specialize in the particular subject of that chapter).
The text is broken down into three main sections: Societies, Minds, and Bodies. Part I: Societies, is broken down into chapters on History and Cultural Diversity, Non-Binary Activism, Academic Theory, and Law. Part II: Minds, is broken down into chapters on Psychotherapy, Psychiatry, and Psychology. Finally, Part III: Bodies, is broken down into the most technically complex chapters, Child and Adolescent Endocrinology, Adult Endocrinology, Chest Surgeries, Surgery for Bodies Commonly Gendered Male, Surgeries for Bodies Commonly Gendered Female, and finally, a chapter on Future Directions. I personally found the first part of the book on Societies to be the most accessible to a general reader who is not professionally trained in a mental health field or clinical medicine, though I gleaned important insight from all of the book’s parts and individual chapters. For the sake of brevity, I will point out a few (of many) key insights from each chapter.
In chapter 2, “History and Cultural Diversity” (the first chapter following the Introduction), authors Ben Vincent and Ana Manzano use various historical examples to show how fluid and diverse articulations of gender are, and how particular contexts generate highly varied expressions of gender (25). In chapter 3, “Non-binary Activism”—my personal favorite chapter—authors S. Bear Bergman and Meg John Barker discuss the important role of non-binary activism in shaping understandings of non-binary experience. Barker gives a historical overview of the progression of activism in this area, while Bergman talks specifically about the development of language, and the power that appropriate and affirming language has on constructions of identity, personal senses of belonging, and social acceptance (39-43). To the contrary, dominant (read: binaristic) language can be used to oppress or harm non-binary people, by making their experiences seem illegitimate or incomprehensible (41). Chapter 4, “Academic Theory,” traces the theoretical lineage of thinking about non-binary gender within the academy, and especially how recent developments in queer and trans theory are challenging the dominant medical and scientific understandings of sex and gender (58-9). Chapter 5, “Law,” discusses the various ways in which non-binary folks interact with the law, as well as ways in which the law (which still insists that gender is binary in nearly all cases!) could adapt to be friendlier and more accommodating to non-binary folks: name changes, relationship recognition, equal access to bathrooms and other public spaces, equality acts, and so on (73, 77).
Chapter 6, “Psychotherapy,” offers the transition into the section on Minds. In the chapter, authors Meg-John Baker and Alex Iantaffi survey the dominant approaches to psychotherapy (namely, psychodynamic, cognitive-behavioral, and humanistic) and show how they are all steeped in the assumption that gender is binary (109). They then offer the possibility of two alternative approaches, namely existential and systemic therapeutic approaches, to be more non-binary affirming (111). In chapter 7, “Psychiatry,” authors Sarah Murjan and Walter Pierre Bouman discuss the ways in which non-binary people interact with the institution of psychiatry. Specifically, they focus on changes in diagnostic criteria in the ICD and DSM, and offer hope that the language used in these clinical diagnostic criteria are moving in the direction of non-binary inclusion (125). Finally, in chapter 8, “Psychology,” Christina Richards offers a detailed and incredibly useful assessment tool for mental health practitioners (150-164). In it, she provides justification for why she includes certain questions in the assessment plan, and how they can help mental health practitioners better understand their non-binary patients. All of the chapters in the Minds section did an excellent job of reinforcing the extremely important point that while non-binary folks do often have worse mental health outcomes (and thus need to utilize mental health services, perhaps at disproportionate rates), this is typically not the result of mental pathology, but is often culturally-contingent—the product of systemic and pervasive bias and discrimination leveled against them, as well as being repeatedly put into distressing situations as a result of their non-normative gender expression (108, 132-133). I think this is an incredibly important reminder for readers, as to not suggest that the mental health needs of non-binary folks are the result of their non-binary genders.
The final section, Bodies, begins with “Child and Adolescent Endocrinology.” In this chapter, Gary E. Butler focuses on the effects of hormonal exposure on sexual and gender identity at various stages of development, as well as the role of therapeutic hormonal interventions for non-binary youth (171). Leighton Seal continues that conversation in chapter 10, only focusing on the effects of hormonal exposure and therapeutic treatments in non-binary adults (183). Seal is clear to point out that non-binary adult hormonal interventions are vastly understudied, and thus not currently fully understood. At present, endocrinologists have to rely on binary-based data, to the detriment of precise and patient-specific care. The following 3 chapters give detailed analyses of surgical options for non-binary folks, focusing on chest surgeries, surgeries for those commonly gendered male, and those commonly gendered female, respectively. All of these chapters, together, paint the picture that when it comes to clinical interventions (and especially surgical ones) there is no one set plan of action for non-binary folks—non-binary people don’t all desire the same level of medical intervention, if any at all, and need to be treated and have their needs assessed on a very individualized basis.
With respect to the intended audience of this text, the editors are clear that they intend for this text to appeal at once to a wide variety of readers, some with an extensive background in the fields being addressed. For this reason, while they hope a general readership will find the text helpful, the authors of the various chapters do not take time to define and explain the professional jargon they are using. This can, of course, be a stumbling block for readers who are not themselves health care providers or academics. And while the editors are upfront about this in their introduction (4), I do think the text would have been more widely accessible and useful had the authors provided brief overviews of the chapters in more accessible language and/or provided a glossary of terms, which a more general audience could refer to, to feel better equipped to engage with the arguments of the more technical chapters.
One conceptual issue that resurfaced, repeatedly throughout the text, was the relation between non-binary gender identities and trans identities. Some of the authors seemed to suggest that non-binary gender identity does fall under the larger “trans umbrella,” though of course is importantly different from binary-trans identity (i.e., mtf or ftm trans identified people, to use language used in the text) (5). Other authors, however, seem more critical of the tendency to lump non-binary gender identification in with other trans identifications, and resist the idea that the label of trans is all-encompassing of any non-cis gender identity or expression (41, 74). The matter, of course, is not purely theoretical—some non-binary folks experience themselves and/or identify themselves as trans, while others do not (131). Still yet, some non-binary folks who would not otherwise identify themselves as trans do so for purely pragmatic reasons. For example, they may use the language of transgender identity to access medical resources or treatments that they believe (and likely are, in fact) more likely to receive if they use the language more familiar to most health care professionals (131, 285. See also McKinnon 2013). Overall, I think the most clear and concise definition we get of “non-binary” comes in chapter 5 of the text, where authors R. Clucas and S. Whittle define non-binary as “an all-encompassing name for those people whose gender identities fall outside the dominant societal gender binary” (74).
One important takeaway from the text is how genuinely difficult it is to make any sort of generalizations about non-binary experience, especially when empirical research is in such preliminary stages (105). There is an incredibly wide range of non-binary experiences (5), and institutions (legal, medical, psychiatric, and otherwise) do a great disservice to non-binary people when they attempt to over-generalize and/or draw broad conclusions on the basis of very limited interactions with non-binary people. The reality is that we know (at least in an empirical sense) very little about the lives, outcomes, and general wellbeing of non-binary folks, and this is due in large part to how difficult it is to collect accurate data (a product of most forms and surveys still only providing binary-gendered options). In fact, we still have little idea of precisely how many non-binary people there actually are (5).
My most significant concern with the text is the general lack of non-binary identified voices (or, at least people who position themselves openly as such), with few exceptions. In the clinical chapters in particular, clinicians wrote about non-binary folks, not as non-binary folks. This is an important distinction, especially in the nascent stages of what will hopefully become a larger literature on non-binary identity, but which is currently incredibly limited. At this crucial time, when so many people are being exposed to non-binary gender identity for the first time, it is absolutely imperative that non-binary people have the opportunity to speak for themselves and tell their stories in their own voices. This is essential if non-binary people are to understand what it is like to be non-binary, from the perspective of people who themselves experience themselves in that way. This concern maps onto a larger critique that I have with the text about the politics of citation – again, it matters whose voices are being included and excluded. With the exception of S. Bear Bergman and Meg-John Barker’s chapter (chapter 3 of the text), very few trans or non-binary theorists, philosophers, or other scholars are cited or engaged with in any substantial way. Similarly, in the medically-oriented chapters, there are no substantive patient testimonies or presentations of first-hand experiences with gender-affirming surgery. To the contrary, there are voices included that arguably should not be cited in a text that is supposed to be inclusive and affirming, but yet are cited as authoritative on these issues. One glaring example is the citing of controversial psychologist Kenneth Zucker (see 267, 282) who, despite an extensive research and publication record on child and youth gender dysphoria lost his job at his Gender Identity Clinic for failing to update his practices to be in line with the most up to date research and gender-affirming best practices for trans and gender nonconforming youth. His clinic has been accused of engaging in “reparative” or “conversion” therapy, which has been incredibly harmful to trans youth, leaving many feeling traumatized and ashamed (Allen 2018, Anderson 2016, Ellis-Peterson 2017). It should go without saying that in the early stages of non-binary scholarship, folks like Kenneth Zucker should no longer be regarded as the authority on trans and non-binary experience, and we need instead to be listening to those who themselves live and identify as non-binary.
This worry—about who is speaking and what language is being used—is echoed (or, at least acknowledge or gestured at) at various points in the text. An important thread running throughout the book has to do with the power of language to shape our understandings of non-binary gender. For instance, in the Introduction, the editors acknowledge the difficulty in finding the proper language to use, when so much of the language and so many of the concepts available to them are rooted in (or are themselves) dominant constructions which are medicalized, pathologizing, stigmatizing, oppressive, and even harmful. Specifically, the editors expressed the concerns they had about naming the chapters that pertained to genital surgery, which they found difficult to do in a way that was at once explanatory, but also free of binaristic medical hermeneutics that do not accurately map onto non-binary experiences (3). They note that the ideal situation would be one in which they were able to create new and imaginative concepts and terms which more accurately capture the variety of gendered experiences, and which are not always already packed with a priori assumptions, but of course this is difficult, given the ability of powerful institutions (medicine, law, psychiatry) to shape the dominant discourses (3, 12, 19, 41, 147. Also see Fricker 2007). And given that non-binary folks are forced to operate in contexts where they might lack the language or otherwise be unable to render their experiences socially intelligible, non-binary people often suffer a lack of understanding, and an inability to get proper uptake from the dominant institutions that do have the power to control concept formation and language use (147).
Overall, I think the editors have put together in important text, which I hope will prompt scholarly engagement and popular response alike. Ideally, more people (and non-binary folks in particular) will begin to think critically about gender, about the way binary-thinking pervades our institutions, and the power that language has to construct our realities and perceptions of others. This text has offered an important entry point for dialogues about non-binary experience in a variety of areas, and I applaud the authors for their significant and novel contribution to the literature.
Allen, Martin. “Western Rhodes Scholar Denounces Upcoming Speech By Controversial Psychologist. The Gazette. March 27, 2018. https://www.westerngazette.ca/news/western-rhodes-scholar-denounces-upcoming-speech-by-controversial-psychologist/article_73ca608a-3102-11e8-aa4a-db1b608d54ff.html. Web.
Anderson, Eric. “Gender Identity Debate Swirls Over CAMH Psychologist, Transgender Program.” The Globe and Mail. February 14, 2016. https://www.theglobeandmail.com/news/toronto/gender-identity-debate-swirls-over-camh-psychologist-transgender-program/article28758828/. Web.
Ellis-Peterson, Hannah. “BBC Film on Child Transgender Issues Worries Activists.” The Guardian. January 11, 2017. https://www.theguardian.com/society/2017/jan/11/bbc-film-on-child-transgender-issues-worries-activists. Web.
Fricker, Miranda. Epistemic Injustice: Power and the Ethics of Knowing. Oxford: Oxford University Press. 2007. Print.
McKinnon, Rachel. “Trouble Making the Change: My Transgender Experience.” The Conversation. September 26, 2013. https://theconversation.com/trouble-making-the-change-my-transgender-experience-18527. Web.